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Saturday, November 30, 2013

The Nutrition Debate #165: Obesity is Not the Problem

Robert Lustig’s UCTV YouTube video
sensation, “Sugar, the
Bitter Truth,”
has been seen almost 4 million times. Recently, the UCSF pediatric
endocrinologist made a sequel, “Fat Chance: Fructose 2.0,” that will
also go viral. It’s 86 minutes long, so you’ll need to set aside a block of
time to watch it, but it’s worth it. Here’s a 45 second excerpt I transcribed (starting
at +/-12:00) that fits in with a theme I’ve been beating the drum about since
The Nutrition Debate #9, “The Metabolic
Syndrome,”
published almost 3 years ago.

Lustig: “Obesity is not the problem.
It never was. They want you to think it’s the problem, but it ain’t the
problem. What is the problem? Metabolic Syndrome is the problem. The cluster of
diseases that I’ve described to you. That’s where all the money goes. Obesity
costs almost nothing. Metabolic Syndrome is 75% of all health care costs today.
And there’s the list right there. [Slide lists: DIABETES, HYPERTENSION, LIPID
ABNORMALITIES, CARDIOVASCULAR DISEASE, NON-ALCOHOLIC FATTY LIVER DISEASE,
POLYCYSTIC OVARIAN DISEASE, CANCER, DEMENTIA] Everybody with me now? Do I have
your attention?”

A
brief recap – What is Metabolic Syndrome”? And how is it diagnosed? Definitions
vary but most have five “risk factors” in common, with the first always being obesity.
It is variously defined as “central
obesity,” or what I have coined “omental adiposity”, or a Body Mass Index
(BMI) ≥30, or elevated waist circumference (men ≥40 inches, women ≥35 inches).
The other four “risk factors” are elevated
triglycerides (≥150mg/dl), reduced
HDL, the “good” cholesterol (men ≤40mg/dl, women ≤50mg/dl), elevated blood pressure (≥130/85mm Hg,
or use of medications for hypertension) and elevated fasting glucose (≥100 mg/dl, or use of medications for
hyperglycemia). If you “present” with 4 out of 5, you have Metabolic Syndrome.
Do I have your attention?

The corollary to “obesity is not the
problem” is equally riveting: “everyone’s
at risk,” as Lustig explains: “Everyone’s at risk, because everyone is exposed.” That, of course, begs the question: exposed
to what?

Dr. Lustig precedes his “obesity is
not the problem” mantra with a nice explanation of the implications of the
difference between subcutaneous fat (fat near the surface of the skin) and
visceral fat (fat around the abdominal organs).The latter is the “bad” type of
obesity. He starts with a diagram showing 30% obese and 70% “normal” weight,
“and everybody assumes that the problem is this group over here [the 30% obese]
because 80% of the obese population is sick in some fashion: type 2 diabetes
problems, lipid problems, hypertension, cardiovascular disease, cancer,
dementia, non-alcoholic fatty liver disease, polycystic ovarian disease, etc.”

“But,” he continues, “you do the math
on this, 80% of 30% [of the 240 million adult population] is 57 million, and it
is those 57 million that are bankrupting the country, so it’s the obese
person’s fault only, and that’s the way everyone views this. This is wrong.
This is a mistake. This is a disaster, actually, ‘cause it’s not correct.
Here’s the real story. In fact, 20% of the obese population is completely
metabolically normal. They have normal insulin dynamics. They don’t get sick.
They live a completely normal life, die at a completely normal age, cost the
taxpayer nothing. They’re just fat.”

“Conversely, up to 40% of the “normal”
weight population has the exact same metabolic dysfunction that the obese do. They’re
just normal weight, and so they don’t even know they’re sick until it’s too late;
because normal weight people get type 2 diabetes, they get hypertension, they
get dyslipidemia, they get cardiovascular disease, they get cancer, they get
dementia, etc. etc. And so, when you do the math on that, that’s another 67
million, and so that’s actually outclassing the 57 million obese, and so the
total is 124 million; that’s more than half [the adult population] of America.”

So, that’s why Dr. Lustig says,
“Everyone’s at risk, because everyone is exposed.” Exposed to what, you ask? Metabolic Syndrome! And how do you
treat Metabolic Syndrome? Answer: you “treat” the risk factors: 1) central
obesity, 2) elevated triglycerides, 3) reduced HDL, 4) elevated blood pressure,
and 5) elevated fasting glucose. And what treatment, pray tell, addresses all
five risk factors for Metabolic Syndrome? In case you haven’t figured it out
yet, the answer is a Low Carbohydrate Way of Eating. No pills, no injections,
no surgery. Just a different way of eating.

Okay, you say, I can see how a low-carb
Way of Eating can help me lose weight and control my blood glucose. And I can
see that as I lose weight (as almost everyone wants to do anyway), how my blood
pressure will go down. (Mine did, from 130/90 to 110/70 on the same meds.) And
maybe I can believe that by eating low-carb, I can lose weight without hunger
and without snacks, and even
keep the weight off, so long as I
continue to eat low-carb. But how can I expect that eating low-carb
will cause my elevated triglycerides to go down and my HDL to go up? Well, mine
did, dramatically: My HDL doubled from
39 to 81, and my
triglycerides
dropped by about two-thirds, from 137 to 49, just by eating very low carb.
Scientifically, an n = 1 means nothing, unless
that n = 1 is you! PS: Here’s another
interesting n = 1 on Low Carb
Lowers Triglycerides
from Dr. Art Ayers’s blog.

2 comments:

Dan I could have told you as much twenty or thirty years or more ago. I, 89, have always eaten a high protein, high vegetable diet, maintained my weight, excellent blood numbers and pressure. For me it is preference: I only eat very modest amounts of carbs because when my doctor in the 50s said a high protein diet for hypoglycemia, I suddenly started losing calcium from my teeth and bones. You need some carbs to prevent that. Anyway, you look great (the photo) and sound as if you're enjoying life. Good. And if you two want to come to the city for something you can sleep over in Jonathan's room with a new double bed, and its own bathroom. Ros

Ros, VLC is not 'high protein,' although 20% is certainly higher than the 10% our government recommends (to avoid the saturated fat and cholesterol). It is the disguised influence of the vegan lobby in Washington.

VLC is LCHF (low-carb, high-fat, as they call in in Sweden). My own goal macronutrient proportions are 5% CHO, 20% protein and 75% fat, by calorie, not weight.

Nobody wants to talk high-fat (because of the SFAs), but that is where Ancel Keys and George McGovern misled us and our nanny state continues to take us with its corrupt bargain with Big PHarma and Agribusiness (and the vegans).

But the tide is turning. The Dietary Guidelines now allow for more fat. Unfortunaely, the specify PUFAs (corn oil and soy bean oil, primarily) as safe, when in fact they (rancid and damaged by heat) are the leading cause of inflammation (as evidence by high hs CRPs).

In addition, a high carb diet damages lipid ratios, lowering HDL-c and raising triglycerides, and statins mostly lower the 'good' LDL (the large-buoyant ones), leaving behind the small-dense LDL-c to get stuck in the erosions of the endothelial layer of our veins (caused by the inflammation), only to be covered up by the cholesterol our body makes (even if we don't eat cholesterol-containing foods) in an attempt to 'put out the fire.' This plaque (cholesterol) is attempting to repair the damage from our dietary missteps, not cause the damage.

Oh well, I could go on and on. Thanks for reading and commenting, Ros.

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.